When it came Donna Batson's turn to process customer deposits at the telephone office in Annapolis in April, she began to get severe headaches.
The headaches would disappear on weekends at home and when she was out of the office, leading her to believe the cause was in the workplace. Two other women doing the same job in that office reported similar symptoms.
Thus began a medical mystery at the Riva Road office of Chesapeake & Potomac Telephone Co., an unsolved mystery that Mrs. Batson and others say is linked to the carbonless copy paper forms used for recording deposits.
The veteran service representative was twice sent temporarily to C&P's Calverton office, where her headaches went away. When she finally came back to the Riva Road office, Mrs. Batson's physician advised her to avoid handling the carbonless copy paper.
Now, her headaches have mostly cleared up. But she believes she is permanently "sensitized" to chemicals in this copy paper after her two-month, temporary stint handling three dozen of the carbonless forms a day.
"Our union believes that at least three people have headaches brought on by the use of carbonless copy paper," said Mrs. Batson, secretary-treasurer of Local 2107, Communications Workers of America. One co-worker transferred to a different site, the other was relieved of duties requiring use of the paper, she said.
C&P responded to the complaints by testing the air for contaminants, installing new air vents and replacing the ventilation system. An industrial hygienist surveyed the office, some employees got company medical exams, and further investigation with the union is scheduled. "They've been very good about it," Mrs. Batson said.
The phone company is still using the copy paper forms. "We have checked the available research on carbonless copy paper and cannot find any hazard or health effect related to it," said Jeanine Smetana, a C&P spokeswoman.
Air quality monitoring of the office building where nearly 200 people work has "not detected anything to cause alarm," she added.
But Mrs. Batson believes that the general lack of fresh, circulating air in the sealed office building has contributed to the carbonless copy paper reactions and other ailments reported by C&P employees working there.
The problem is typical of so-called "sick building" ailments experienced by growing numbers of office workers who appear to develop chemical sensitivities, said David LeGrande, national safety and health director for the Communications Workers union.
In the Annapolis case, he said, carbonless copy paper appears to be the cause of the sensitivities, because the workers develop the symptoms after they handle the material.
But, he added, "We are having difficulty getting good chemical information to prove it."
Since carbonless copy paper was introduced during the 1950s, complaints of worker sensitivity reactions -- mostly skin irritations, respiratory problems and headaches -- have surfaced sporadically, and some scientific studies claimed to find links between the paper and health problems.
The product uses microcapsules of dyes and solvents coated on the underside of paper that are broken by pressure of writing or typing and make a copy of the writing on the sheet underneath.
More than 2 million tons of it are used worldwide each year in such products as multipage business forms, credit card sets and two-part checks.
But with hundreds of kinds of carbonless paper on the market and changing chemical formulas, it is extremely difficult to pinpoint a specific ingredient or recipe that can cause adverse health effects, said government toxicologist Dr. Kent Hatfield.
"It is like trying to grab fog," said Dr. Hatfield, who coordinated the 1987 research project for the National Institute for Occupational Safety and Health on health effects of carbonless paper.
The agency got a tall stack of responses from the paper manufacturers but little medical substantiation from suspected victims and their doctors, he noted.
Many of the health studies cited have flaws, concrete medical data are lacking, and identification of chemicals is elusive, he said. Some studies were useless because the target chemicals are no longer used by manufacturers, he added.
"It didn't take me long to realize that I was in a no-win situation," he said. "I was never going to find the cause of the problems." NIOSH has put the research project on hold, in large part because the symptoms are not life-threatening and are not widespread, he explained.
And yet, Dr. Hatfield knows that workers have become ill from handling one kind or other of carbonless paper, even if the confirmed numbers are relatively small.
"There are people, because of genetic makeup, who are sensitive to these compounds. They have been compromised health-wise," he said. "These people are sincere, and they need a fair break in their workplace." Moving the affected person to another room, or changing duties or even the type of copy paper are reasonably simple remedies, Dr. Hatfield said.
In a number of cases, he said, the individual's reaction seems to occur through skin contact, rather than from chemicals in the air. So air quality monitoring may not detect any source of an individual's reaction, he cautioned. Historically, some carbonless copy paper has contained chemicals that are known to be toxic, such as PCBs (polychlorinated biphenyls) and free formaldehyde, but these ingredients have been removed by the manufacturers over the years, Dr. Hatfield pointed out.
Moore Business Forms Inc., which makes the form used in the C&P office, said its ongoing safety testing results "show that [Moore's product] poses no hazard to the people who manufacture or use it."